Outcome of post caesarean pregnancy and comparison of maternal and foetal outcome following vaginal birth versus repeat caesarean section in a rural hospital

Shruti S. Goel, Mahima Tiwari, C. Hariharan, Deepti S. Shrivastava

Abstract


Background: The study was performed to assess the maternal and fetal outcome in  post caesarean pregnancy as well as the various indications of a repeat caesarean section, so  that, a definite protocol can be designed for selection of patient who is fit to undergo trial of  labour after a previous caesarean section. This can reduce the rate of repeat caesarean section.

Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha, India from August 2010 to July 2012.

Results: During this period, a total 100 study cases with previous caesarean section were studied, of which 51 cases were selected for trial of vaginal delivery. 51 study cases were given trial of labour out of which 31 delivered vaginally. VBAC success rate at our institution during our study period was 60.78%. Out of total 69 cases who underwent caesarean section, maximum study cases presented with fetal distress 17(24.64%). Total 37 study cases were delivered by emergency caesarean section, maximum 17(45.94%) had indication of fetal distress followed by scar tenderness in 7(18.91%) cases.

Conclusion: Substantial reduction in the caesarean rate can be achieved safely and efficiently by encouraging the trial of labour in women with a single previous caesarean delivery. Caesarean section should not be always followed by repeat caesarean section but patients must have hospital delivery in well equipped hospital and complications should be diagnosed at an early stage so that we can prevent maternal/ perinatal mortality and morbidity.


Keywords


Vaginal birth after caesarean section, Trial of labour after caesarean section (TOLAC), Lower segment caesarean section, Repeat caesarean section, Maternal morbidity

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